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Re: Active Surveillance Biospy intervals

Guys, guys,

Don't forget the golden rule of prostate cancer "There Are No Rules".

TomF: I beieve that in your case six monthly biopsy procedures are an overkill. Most AS protocols refer to an annual biopsy, but some of the studies and pracitioners are moving away from that recognising that in the evnt of PSA stability, DRE unchanged, no symptoms, the disease is indeed an indolent one and less frequent biopsy is appropriate. The protocol I used for myself precluded any biopsy procedures after my second because of their lack of accuracy. Instead on the advice of a somewhat maverick European urologist I used PSA, symptoms and three yearly bone scans as my protocol. Not saying I was right, but it'll be sixteen years in August.....

Alan, I now from you previous posts and mails that you are what might be termed a 'worrier' if we were to categorise people. And as such you tend to take the worst case scenario instead of the best - or even to clearly understand that there is a range of outcomes rather than one definitive one.

Here you have a difference of opipnion about whether there might be perineural invasion or not. You choose to believe that there must be and assume the worst - that it is very likely that the disease has spread, that your options are now limited, that your life expectancy may be reduced.....

You may be right on all counts.....and yet.....there are many studies that indicate that evidence of perineural invasion does not impact on ultimate outcomes.

Is the glass half full or half empty?

All the best from a professional optimist (based on my life experiences where nothing is ever as bad as I imagined it might have been)

Terry in Australia

Re: Active Surveillance Biospy intervals

Hi Terry,
I hear ya on the no rules & everyone's tolerance level is different for the AS route. But, I am definitely going to go with the Urologist who is OK with a yearly biospy. On the subject of PSA tests, I am not convinced there is a good reason to have them done in between the biospy intervals given what I now know about the questionable of accuracy of results as a cancer marker. What do you think?

Re: Active Surveillance Biospy intervals

I'm with you Tom - and my oncologist would agree too, I think.

Good luck to you. We are all different, we have diferent ways of looking at risk and assuming risk. There is no "right" way, just what we are each comfortable with.

Just let us know how things go.

All the best

Terry in Australia

Re: Active Surveillance Biospy intervals

Will do, thanks Terry!

Re: Active Surveillance Biospy intervals

Tom:

Your results are very similar to mine and I wished to respond as I have been doing AS since October of 2010. I am turning 65 in three weeks and the comment from my urologist when diagnosed was, "You're young enough and with your numbers you could choose to take your time in making a decision." When I decided to do AS, he said that I would need a follow-up biopsy on the one-year anniversary of my diagnosis but do a PSA and DRE every three months to make sure nothing was going astray too fast. I will be making a decision shortly on a more permanent treatment and feel that, to date, this was a prudent course to follow with my urologist. My son-in-law is a urologist as well and said most patients will stay with AS no longer than two years and then pursue surgery or other form of treatment.

My best to you,
John

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